Risk Factors for Ocular Complications and Poor Visual Acuity at Presentation Among Patients With Uveitis Associated With Juvenile Idiopathic Arthritis

Abstract

Purpose-To describe the frequencies of and risk factors for ocular complications and poor visual acuity at presentation in a cohort of patients with juvenile idiopathic arthritis (JIA)-associated uveitis.Design-Cross-sectional study.Setting Single-center, academic practice. Procedures Data on patients diagnosed with JIA-associated uveitis were entered retrospectively into a database and analyzed. Study populationOutcome measures Visual acuity of 20/50 or worse or 20/200 or worse, and presence of ocular complications (including cataract, posterior synechiae, band keratopathy, elevated intraocular pressure, hypotony, macular edema, and epiretinal membrane) at presentation.Results-At presentation, ocular complications were seen in 67% of eyes affected by JIAassociated uveitis. Presence of ≥ 1+ anterior chamber flare, a positive antinuclear antibody, and a shorter duration between the diagnosis of arthritis and uveitis were significantly associated with the presence of ocular complication. The frequencies of 20/50 or worse and of 20/200 or worse visual acuities at presentation in affected eyes were 36% and 24%, respectively. The presence of ≥ 1+ anterior chamber flare and a history of intraocular surgery prior to presentation were significantly associated with 20/50 or worse and 20/200 or worse vision. Presence of posterior synechiae also was associated with 20/200 or worse vision at presentation. The main causes of poor vision at presentation for affected eyes and better-seeing eyes were cataract, band keratopathy within the visual axis, and glaucoma.Conclusions-Ocular complications and poor vision at presentation were common in our patients with JIA-related uveitis.

Optical coherence tomography imaging in uveitis

“…Maculopathy has been documented by OCT in 84 % of eyes with JIA-associated uveitis [57], a much higher figure compared to previous reports mostly based on ophthalmoscopic findings (3.9-26 %) [61][62][63][64]. Macular changes determined by OCT included perifoveolar thickening in 74 %, macular edema in 48 %, foveal detachment in 18 %, and atrophic changes in 10 % of eyes with JIA-associated uveitis [57].…”

Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis–associated uveitis: A consensus effort from the multinational interdisciplinary working group for uveitis in childhood

“…Clinical macular edema causes vision loss in 3-26% of patients with JIA-associated uveitis 1368 Heiligenhaus et al (19,24,25). It has probably been underestimated prior to the widespread use of fundus lenses and optical coherence tomography (OCT).…”

Treatment Approach for Juvenile Idiopathic Arthritis-Related Uveitis: 2012 Update

“…В результате современные стратегии терапии в широких пределах варьируют по типу и временным параметрам и часто не обеспечивают адекватного контроля воспаления тка-ней глаза, вследствие чего побочные эффекты и неблаго-приятные исходы со стороны органов зрения встречаются довольно часто [59][60][61]. Таким образом, разнообразие вариантов лечения и сроков назначения наиболее актив-ной терапии являются критическими аспектами при увеи-те, обусловленном ЮИА, и могут отражать различие наблюдаемых исходов.…”